Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a group of lung diseases. It includes chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have difficulty breathing.

You usually won't notice COPD until after the age of 35. Most people who are diagnosed with it are over 50 years old.

• you feel more breathless than usual when you exercise or move around
• you have a cough with mucus (phlegm) that never seems to go away
• you get chest infections often, particularly in winter
• you're wheezing
• you're a smoker, or used to be one, and you have a persistent chesty cough, especially in the morning
• you have COPD and you're having a flare-up (a spell of particularly bad symptoms) that's worse than normal

Chest pain and coughing up blood (haemoptysis) are not common symptoms of COPD.

The sooner chronic obstructive pulmonary disease (COPD) is diagnosed, the better.

Your doctor may:

• ask about your symptoms
• ask whether you smoke, or used to smoke
• listen to your chest using a stethoscope
• weigh you to measure your body mass index (BMI)
• check how well your lungs are working with a breathing test called spirometry
• want to rule out other conditions with tests like a chest X-ray or blood test

You may need more tests to confirm you have COPD or to check how severe it is. These tests may include:

• an electrocardiogram (ECG) or echocardiogram to check the condition of your heart
• peak flow tests to measure how fast you can breathe out, and rule out asthma
• a blood oxygen level test using a pulse oximeter (it looks like a peg attached to your finger) to see if extra oxygen would help you
• a blood test to check if you have a genetic tendency to COPD (alpha-1-antitrypsin deficiency)
• a computerised tomography (CT) scan to see any changes to the lung
• more detailed lung function tests than spirometry (you may be referred to a hospital for these)
• a phlegm sample to check for infection

There is no cure for chronic obstructive pulmonary disease (COPD) at the moment. But the sooner you start treatment, the less likely you are to have complications and flare-ups. Damage that has already happened to your lungs can't be reversed. Even so, treatment can slow COPD down and help you feel better, especially if you stop smoking.

Most treatment for COPD is about easing the symptoms with medicine. For example, an inhaler can make breathing easier. Pulmonary rehabilitation may also help you do more exercise than you can now.

Surgery is an option for only a small number of people with COPD, and lung transplant is an option for people under 60.

If you have chronic obstructive pulmonary disease (COPD), stopping smoking is the best thing you can do to feel better.

The earlier you stop in the course of the disease, the more difference it makes. Any damage already done to your airways can't be reversed. But giving up smoking can slow down how fast the condition gets worse.

If you've been prescribed an inhaler for COPD (chronic obstructive pulmonary disease), your healthcare professional can explain how to use it. Asthma + Lung UK also has videos on how to use your inhaler.

Short-acting bronchodilator inhalers put a small dose of medicine straight into your lungs. This makes the muscles in your airways relax and open up.

There are 2 types of short-acting bronchodilator inhaler:

• beta-2 agonist inhalers, such as salbutamol and terbutaline
• antimuscarinic inhalers, such as ipratropium

Use the inhaler when you feel breathless, to relieve the symptoms.

If a short-acting bronchodilator inhaler doesn't help your symptoms, your doctor may recommend a long-acting bronchodilator inhaler. It works in a similar way to a short-acting one, but each dose lasts for at least 12 hours.

There are 2 types of long-acting bronchodilator inhalers:

• beta-2 agonist inhalers, such as salmeterol, formoterol, vilanterol and indacaterol
• antimuscarinic inhalers, such as tiotropium, glycopyrronium and aclidinium

You'll usually be given a combination of these.

Steroid inhalers, also called corticosteroid inhalers, can help reduce how often exacerbations or flare ups happen in some people with COPD.

There is no recycling scheme available for used inhalers. Return all your used or expired inhalers to your community pharmacy for safe disposal. Spacers should be replaced each year if you use them regularly. Old spacers go into the household bin.

Using your preventer inhaler correctly and keeping your symptoms under control is good for your health and for the environment. Some inhalers have a lower carbon footprint than others and are better for the environment. The best inhaler is the one that works well for you. Speak to your healthcare professional about whether inhalers with a lower global warming potential would be right for you.

Your doctor may prescribe medicines such as these for chronic obstructive pulmonary disease (COPD):

• mucolytic tablets or capsules, which make your phlegm easier to cough up (they suit people with lots of thick phlegm, or those who have frequent or bad flare-ups)
• antibiotics, if you have a chest infection
• steroid tablets, if you have a bad flare-up

Other treatments for chronic obstructive pulmonary disease (COPD) include:

• nebulised medicine (for severe cases where inhalers have not worked), where a large dose of medicine is taken through a mouthpiece or a face mask
• oxygen therapy (if your oxygen levels are low), where you take oxygen through tubes in your nose or through a mask
• non-invasive ventilation (NIV), which helps you breathe using a portable machine connected to a mask covering the nose or face
• pulmonary rehabilitation programmes, which are exercise and education to help people with chronic lung problems. You can ask your doctor if this is available

COPD (chronic obstructive pulmonary disease) can have several causes:

• genetics (COPD-G)
• abnormal lung development, early life events, premature birth, low birth weight, neonatal ventilation (COPD-D)
• smoking including in utero (from before birth), passive smoking, vaping, cannabis (COPD-C)
• pollution from outdoor air, wildfire smoke, occupational hazards, household pollution (COPD-P)
• infections (COPD-I)
• unknown cause (COPD-U)

Smoking is the main cause. The more you smoke, and the longer you've been smoking, the more likely you are to develop COPD. This is because smoking irritates and inflames the lungs and stops them functioning normally, which leaves scarring. Passive (second-hand) smoke can also cause it.

Over many years, the inflammation leads to permanent changes in the lung. The walls of the airways thicken and more phlegm is produced. Damage to the delicate walls of the air sacs in the lungs causes emphysema, and the lungs lose their normal elasticity. Smaller airways also become scarred and narrowed. These changes bring on the breathlessness, cough and phlegm that go with COPD.